Pediatrics Exam #2 Flashcards

Question

Contraindications to live vaccines

Answer 1

Severe immune suppression resulting from: Congenital HIV Leukemia/Lymphoma Cancer therapy 2mg/kg/day 2+ weeks steroids

Answer 2

Under 6 months and egg allergies Can do flumist at 2

Answer 3

If severe reaction give in a setting equiped to handle anaphylaxis

Answer 4

Febrile seizures: Exercise caution

Answer 5

Don't give in pregnancy

Answer 6

Primary - Before a first occurence Secondary - After an exposure

Answer 7

ANyone with contact that has had direct exposureRifampin BID for 2 days Rocephin and Cipro

Answer 8

Wash wound, give tetanus toxid and immuneglobulin

Answer 9

Healthy appearing animal - observe for 2 days screen for rabies if we can - neg screen don't treat Captured wild animal - euthanize and test, treat if positive

Answer 10

Skunks Raccoons Foxes Woodchucks Bats

Answer 11

If we find a bat in the vicinity -rabies until proven otherwise

Answer 12

Ig SQ around the would 3,7,14 in abdomen 21 for immune comp

Answer 13

Whenever hungry - feed every four hours for first 4 weeks

Answer 14

Sticking out lips/tongue Cry Rooting Sucking does not always mean hunger

Answer 15

2-4 ounces every 3-4 hours

Answer 16

4-6 oz per feeding

Answer 17

4-5 oz per feeding

Answer 18

Colic, Stomach pain, gas, spit up

Answer 19

2-3 first 4-5 days 5-6 after that May not pass stool daily if breast fed - pay attention to comfort

Answer 20

400 IU per day at birth Only exception is when drinking 32+ oz of formula

Answer 21

Needed for breastfeeding - 1mg/kg/dqy

Answer 22

Loose up to 7% birth weight and then gain it back Follow up weight 3-5 days after birth Gain 15 grams per day

Answer 23

3 months - no food until 4 months

Answer 24

Single grain cereal at 4 months Baby food with new fruits/veggies every 4 days at 6 months Meats start at 9 months

Answer 25

Can hold head up Can sit up Open mouth for spoon Track spoon

Answer 26

Introduce when other complimentary foods are - introduce early on if no eczema or allergies

Answer 27

3-7 mm - may be allergic

Answer 28

At first birthday Limit to 16 oz per day

Answer 29

Calorie requirement drops sharply - careful to give smaller serving size

Answer 30

Takes up to 20 times - keep trying, don't replace healthy with unhealthy

Answer 31

Give options out of healthy choices 3 meals a day and 2 healthy snacks Don't use food for a reward Don't eat and watch TV

Answer 32

Fat under 30% of cals 55-60% cals from carbs Limit sodium from processed foods

Answer 33

40 calories for every inch of height recommended between 1 and 3 years

Answer 34

Later bedtime Diabetic parents

Answer 35

Hormone stimulating hunger secreted by stomach

Answer 36

Hormone secreted byfat suppressing appetite - decreases with decreasing fat

Answer 37

Hormone secrete by SI suppressing appetite after meals

Answer 38

5-84 percentile

Answer 39

5+ fruits and veggies daily 2 hours max screen time per day 1 hour of active play 0 Sugary drinks Choose one to work on

Answer 40

2 cupped hands

Answer 41

1 cupped hand

Answer 42

None for first two years

Answer 43

4-12mo -12-16 1-2 - 11-14 3-5 - 10-13 6-12 - 9-12 13-18 - 8-10

Answer 44

Phentermine - controlles Qsyma - Not approved for children Topiramate - not approved but has been used

Answer 45

Must be over 15 with BMI over 40

Answer 46

3 of 5 Waist circ over 90th percentile Hypertriglyceridemia (over 110) HDL under 40 HTN over 90th percentile Fasting glucose over 110

Answer 47

Loss of genes from chromosome 15q - leads to morbid obesity

Answer 48

Hypotonia, feeding issues, excess weight gain, hypogonadism, facial change, developmental delay, excess eating

Answer 49

Check every 1-3 months Refer to dietician or weight loss specialist if not improvement at 3-6 months

Answer 50

Autism screening for autism Done at 18 and 30 month

Answer 51

19 age-specific questions from one month to 9.5 years

Answer 52

Communication Gross motor Fine Motor Problem Solving Personal/Social Graded 0,5, or 10

Answer 53

Communication - Coo and Goo Gross motor - Head erect, turn side to back Fine Motor - Drops toys Problem Solving - Follows objects Personal/Social - Smiles and recognizes parents

Answer 54

Communication - Raspberry sound, Laughs Gross motor - Sits with support, Turns front to back Fine Motor -Ulnar grasp, objects to mouth Problem Solving - Can follow an object but no permanence Personal/Social - Looks towards voice

Answer 55

3-5 months - can lift head up on tummy

Answer 56

Communication - Babbling Gross motor - Sits alone for short period, commando crawl, back to stomach Fine Motor - Bye bye wave, Scoop and grasp, feed self, hand to hand pass Problem Solving - N/A Personal/Social - Inhibited by "no"

Answer 57

Communication - Babbling with sound repetition, follow 1 step commands Gross motor - Full crawl, Pull self to standing, can stand alone briefly Fine Motor - Neat pincer grasp Problem Solving - Object permanence Personal/Social - Understand name and some words, immitates pat-a-cake and peek-a-boo

Answer 58

Communication - Mama and Dada specific, peak babbling Gross motor - Starts to walk on own Fine Motor -Perfects pincer grasp, two cube tower, points to desired objects Problem Solving Personal/Social - Gives toys on request

Answer 59

Communication, 4-20 words Gross motor - Seats self in chair, walk down stairs, throw ball Fine Motor - Dumps things from cups/bottles, feeds self Problem Solving Personal/Social - recognizes 3 body parts

Answer 60

They direct you to an even by pointing

Answer 61

Sees something they want, looks at you and back at the object

Answer 62

Communication - 50 word vocabulary, can say short phrases Gross motor Fine Motor - 6-7 cube tower Problem Solving, turn pages Personal/Social - Points to named objects, plays with mimicry, kicks ball on request

Answer 63

Communication - Use prepositions, Uses I not Me Gross motor - Walk backwards, hop on one foot Fine Motor - Copies crude circle, hold crayon in fist Problem Solving Personal/Social - Point to object described by use, carry a conversation

Answer 64

Rule of 3s 3 numbers, 3 colors, 3 shapes, 3 wheel bike 9-10 cube tower

Answer 65

Climbs stairs with alternating feet Button and unbutton What do you do for fun answer Knows sex Gives full name Feeds self Takes off shoes and jacket

Answer 66

Runs and stands on one leg Draw person with no torso Copy a square Knows days of week What do you do if...cold....hungry Self care at toilet Dress self

Answer 67

Catch a ball Skip smoothly Tell age Know left and right Describe favorite TV show Simple chores Low danger awareness

Answer 68

Knows morning and afternoon Reads one syllable printed words

Answer 69

Ties shoes Knows day of the week Add and subtract 1 digit numbers

Answer 70

No smile/joy by 6 months No sitting at 9 Moro past 6 months No babbling by 12

Answer 71

No single words by 16 months Not walking by 18 months Hand dominance before 18 months Failure to have 2 or 3 word sentances at 2 and 3 years respectively

Answer 72

Any regression on skills

Answer 73

50%, 75%, 100% respectively

Answer 74

Weight alone is dropping, head an height continue

Answer 75

Drop in height and weight - heart or lung disorder

Answer 76

All three parameters are low - brain or chromosome issue

Answer 77

Below 10th percentile weight baby

Answer 78

All parameters small due to issue early in pregnancy - worse prognosis

Answer 79

Only weight is under 10% - late in pregnancy, HTN, better prognosis

Answer 80

90 percentile or more - diabetic or large mother

Answer 81

Children who fall below the 3rd percentile on the growth curve OR Weight has declined across 2 major percentiles

Answer 82

Focus on nutrition and rehabilitation - avoid refeeding syndrome

Answer 83

100% of daily age requirements given based on day 1 weight, if well tolerated start phase 2

Answer 84

Increase intake to provide catch-up nutrition

Answer 85

Offer varied diet as child approaches ideal body weight

Answer 86

Evaluate by pediatric endocrinologist

Answer 87

Average of mom and dad +/- 6.5cm if boy or girl respectively

Answer 88

There is an issue with growth velocity

Answer 89

Grows along growth curve staying at or below 3rd percentile

Answer 90

Delayed onset of puberty with a growth spurt later , follow growth curve and then shoot up Bone age under calendar age

Answer 91

Order IGF-1 and IGFBP for levels of GH estimate Decreased growth velocity Micropenis in males

Answer 92

Due to emotional deprivation Less eating, speech retardation

Answer 93

Start as soon as possible - first month of life is ideal Levothyroxine is drug of choice

Answer 94

Methimazole first choice Beta blockers for tachycardia Can also use PTU

Answer 95

Flushing, jaundice Treat w/ steroids and BB temporarily

Answer 96

Breast dev before 8 in girls (7 for AA)

Answer 97

Activation of GnRH leading to an increase in sex steroids Events identical to normal puberty

Answer 98

Ovarian or adrenal tumors, Mcune Albright syndrome Elevated estrogen levels and more rapid changes

Answer 99

Give leuprolide to downregulate GnRH

Answer 100

Changes before age 9 More likely to have CNS abnormalities

Answer 101

No signs by 13, no period by 16 No tanner stage 5 within 4 years of onset = delay Low dose estrogen and then OCP

Answer 102

No secondary sex characteristics by 14 or no final maturation within 5 years of change beginning Low dose testosterone to treat

Answer 103

Constitutional growth delay

Answer 104

Vomiting, Jaundice, Liver inflammation Need lactose free milk Newborn screen

Answer 105

Mental impairment, hyperactivity, seizures, eczema Limit dietary phenylalanine

Answer 106

Don't have any idea of how deep things are - think pool is a bath

Answer 107

Until two years old and up to 35 lbs. - across chest, etc.

Answer 108

5 point harness until at least 4 or 40lbs.

Answer 109

Belt positioning booster seat to get seat belt across hips NOT belly

Answer 110

Must be discarded

Answer 111

60-90% reduction

Answer 112

Hits hard surface Fall results in marks on shell Over 5 year old helmet

Answer 113

Get them to temperature before declaring prognosis Warm water is worse

Answer 114

Warm up 100% O2 Intubation if satting under 80 IVF NG tube

Answer 115

Within 5 minuts by both parents

Answer 116

Cool compress and analgesics

Answer 117

Silvadene and analgesics with sterile non adhesive dressing

Answer 118

Referral, IVF, Airway

Answer 119

Watch for entrance and exit wounds EKG, CK, UA, BMP

Answer 120

High pressure and high volume irrigation Tetanus and Rabies prophylaxis Suture bites only if you have to - open sutures Pasturella -tx with augmentin

Answer 121

Under 1 - Hard back blows Over 1 - Heimlich

Answer 122

Face on AP view

Answer 123

Can attract in abdomen and loop the bowel

Answer 124

Only on non paved surface No passenger Helmet Prohibited under 16 years NOT TOYS

Answer 125

Likely to experience another in the next 10 days after concussion

Answer 126

Used to determine return to play

Answer 127

No activity Light aerobic exercise Sport specific exercise Non-contact training drills Full contact practice Must be symptom free for 24 hours to move to next level

Answer 128

Used to do gastric lavage, now more common NG tube with activated charcoal

Answer 129

Heavy metals Inorganic ions Corrosives Hydrocarbons Alcohols Essential oils

Answer 130

Depressed Late presentation Risk for aspiration - hydrocarbon Need endoscopy Toxins not well absorbed Intestinal obstruction

Answer 131

N-Acetylcysteine 150mg/kg loading dose over 15-60 minutes 50mg/kg over 4 hours 100mg/kg over 16 hours

Answer 132

Flintstone vitamins, etc. Leads to hemorrhagic gastroenteritis, Phase of improvement, and then delayed shock and liver damage Gastric lavage and whole bowel irrigation

Answer 133

Succimer 10mg/kg every 8 hours for 5 days then every 12 hours for 4 days

Answer 134

45+ mcg/dL

Answer 135

5-9mcg/dL should be confirmed within 1-3 months and reapeated after 3 months, then 6-9 months after environmental changes are made

Answer 136

Get out if stuck in esophagus - can erode it

Answer 137

Newborn - 24-48 hours 2 weeks 1,2,4,6,9,12,15,18,24,30,36 months Yearly after 3 years

Answer 138

Height and weight every visit Head circumference first three years BMI staring at 2

Answer 139

Falling by two major percentiles in 6 months Weight or length under 5th percentile

Answer 140

Start at 3 years Unless they have congenital heart disease

Answer 141

Greater than 95th percentile or greater than 130/80 (just the last over 13 Need 3 abnormal readings

Answer 142

BMP, Lipids, Renal US Do an echo before starting meds

Answer 143

Red reflex FIxate at 6 weeks Formal acuity testing begins at 3

Answer 144

3-4 - worse than 20/40 5 - worse than 20/30 6 - worse than 20/20 - should have normal adult vision at this point Strabismus or Abnormal red reflex

Answer 145

MCC of hearing loss is congenital infection Screen neonates with follow up for abnormal results and bring back in two weeks Get in the system before 6 months Once a year after 5

Answer 146

Becomes voluntary at 4 months

Answer 147

Disappears by 4 months

Answer 148

Disappears by 3-6 months

Answer 149

Disappears by 3-6 months

Answer 150

Disappears by 4-6 months - should disappear before baby can roll back to front

Answer 151

Disappears after 6 months

Answer 152

Disappears at 2 months

Answer 153

Disappears at 1-2 months

Answer 154

At 6 months, may be normal before 6 months but should not persit

Answer 155

Closes at 9-18 months

Answer 156

Closes at 2-3 months

Answer 157

Sit the baby up at 45 degrees to avoid

Answer 158

Can be due to premature closure of the sutures - if ears are not across from each other/assymetry there is premature closure of the sutures

Answer 159

Premature closure of sagittal suture - narrow and long head

Answer 160

Multiple suture closures -growth of head upwards

Answer 161

Frontal suture early closure Triangular forehead with midline ridge

Answer 162

Due to baby back sleeping, give the baby tummy time during the day

Answer 163

3D CT scan Maxillofacial surgeon if no improvement by 9-12 months Bloddiest surgery Skull molding helmet

Answer 164

Done with eruption of first teeth usually around 5-8 months Official dentist visits start around 1 Sucking should be discontinued around 4-5

Answer 165

Teething should not cause a fever

Answer 166

Clean gums after bottle feed Teeth cleaning twice a day supervised until 8 Floss when spaces between teeth become too small for brush

Answer 167

Under 3 - rice sized 3-13 - Pea sized 13+ slightly larger than pea sized

Answer 168

Children from 1-2 years This is when anemia peaks - can be due to excessive milk intake

Answer 169

FInger/heal stick and then follow up with venous stick

Answer 170

Not recommended in healthy, asymptomatic pediatric patients

Answer 171

Identify high risk and screen only them

Answer 172

COuntry of origin with high rates Spent time with TB+ people Latent TB

Answer 173

May not be able to obtain a sputum culture Diagnose based on: Clinical s/s after exposure +Skin test or blood test +CXR

Answer 174

Home - are they safe at home Education Activities/Employment Drugs Suicidality Sex

Answer 175

Discuss breast feeding - every 2-3 hours or 8-12 times/day Pooping/peeingok Circumscision check Patency of nose and ears Weight Back to sleep

Answer 176

Sponge bath until it falls off

Answer 177

Lactation, sleep of mom and baby Check newborn screen and review Vitamin D supplement if breastfeeding Jaundice should resolved

Answer 178

Growth and nutrition Hep B if not given at birth

Answer 179

Same vaccines each time 4 - no longer need to wake for feeds 6 - solid food introduction 1 type at a time Sit, stand, speak, swipe, slobber, switch

Answer 180

Start table food - nothing needing chewing No vaccines unless catchup Mama, dada, gross pincer

Answer 181

Starting to walk Whole milk introduced MMR, Hep A Varicella 1st dentist referral Fine pincer

Answer 182

Delayed fevers with live vaccines - MMR, Varicella

Answer 183

15 - 5 words, climbing, body parts 18 & 24 -MCHAT/ASQ

Answer 184

Genital exam - tell them only mom dad doctor can do this

Answer 185

Under 3 - no need to follow up if low risk 3-7 - Administer follow up, intervention if score 2+ 7+ - Bypass follow up and refer

Answer 186

THose built before 1950

Answer 187

Can end at 36 months Need a venous sample

Answer 188

Counsel on exposure risk if level 10-19 mcg/dL Workup and screen for anemia at 20-44 mcg/dL Activated charcoal at 45-69 mcg/dL Hospitalize and contact poison control at 70+mcg/dL

Answer 189

EDTA or Dimercaprol (adjunct to EDTA), Succimer

Answer 190

Too little - caries Too much - Dental mottling

Answer 191

Not needed if 0.6+ ppm in water supply 0.3-0.4 ppm - 0.25 mg recommended Under 0.3ppm - 0.25 from 6 months to three years, 0.5 3-6 years, 1mg 6-16 years

Answer 192

Excess fluoride intake causing mottling of teeth

Answer 193

Suicide Homicide Abuse + HIV status

Answer 194

Emergency care Sex ed starting 6th grade Birth control HIV testing

Answer 195

Get married Join Military Judge declares emancipated - 16

Answer 196

Over 14 who: Demonstrate decision making capacity Non major intervention Intervention not for another STD treatment

Answer 197

Screening Counseling for risk Immunizations General health education

Answer 198

1-2 hours per day

Answer 199

Changes in activity Changes in emotions Changes in behavior

Answer 200

MVA then Suicide

Answer 201

Firearm and Suffocation

Answer 202

Missing 1 week or more of school for an illness which would require serious treatment

Answer 203

Over 130/80 in over 13 - 3 separate occasions at least 1-2 weeks apart

Answer 204

Over 140/90

Answer 205

120/80 -129/80

Answer 206

Between 90 and 95th percentile or between 120/80 and 95th percentile

Answer 207

Between 95th percentile and 95th percentile + 12 mmHg (lower one) or between 130/80 and 139/89

Answer 208

Over 95th percentile + 12mmHg or over 140/90

Answer 209

Stage I - d/u in 3 months if asymptomatic and counsel - may play sports Stage II - Repeat in one week but initiate lifestyle modification Medication NO SPORTS

Answer 210

CBC, CMP, UA (for kidneys), Lipids, Renal US, Echo, HbA1C, TSH, Sleep study for OSA

Answer 211

Lisinopril to start, consider ARB, THiazide, CCB

Answer 212

Breast bud onset - may not start on same day

Answer 213

Armpit hair and genital hair

Answer 214

Androgen dependant changes

Answer 215

First period, 2-3 years after thelarche

Answer 216

Takes 4-5 years Girls start at 10.5, girls at 11.5

Answer 217

Breast - Preadolescent Pubic Hair - None Genitalia - Childhood size

Answer 218

Breast - Breast bud Pubic Hair - None Genitalia - Enlargement of scrotum/testes

Answer 219

Breast - Areolar diameter enlarges Pubic Hair - Darker, curling, increased amount Genitalia - Penis lengthens, testes enlarge

Answer 220

Breast - Secondary mound, separation of contours Pubic Hair - Coarse, curly, adult type, Genitalia - penis grows in length and breadth, scrotum darkens

Answer 221

Breast - Mature female Pubic Hair - Extends to thighs Genitalia - Adult shape and size

Answer 222

3,4,10,16,25 Almost square numbers

Answer 223

Usually bilateral and tender Majority go away in 1-2 years 70% end before 17yrs

Answer 224

Secondary sex characteristics under 8 in girls (7 for AA girls) less than 9 in boys Just as worried about this as delayed

Answer 225

Later than: 12-13 in girls or no menses at 16 14 in boys

Answer 226

Being pregnant

Answer 227

A PPE is not comprehensive and does not substitute for a well child check

Answer 228

Athletes line up single file and physician examines them Few personel but noisy and not private

Answer 229

Get checked out for diffierent things at different stations - for large volumes

Answer 230

Individual provider may lack training May not know all that their PCP knows

Answer 231

Once can concentrate and tolerate visual and auditory stimulation for 30-45 minutes May need academic adjustments

Answer 232

Need to be able to return to play symptom free and off meds -baseline balance and cognitive function 2 weeks min

Answer 233

Structural brain abnormailty on imaging Nonresolving/Prolonged neurocognitive defecits

Answer 234

Louder standing and valsalva Quieter squatting

Answer 235

Louder squatting, quieter with valsalva/standing

Answer 236

Long arms, legs and fingers Curved spine Pectus excavatum Crowded teeth Stretch marks not related to weight gain/loss

Answer 237

Vision worse than 20/40 in at least 1 eye

Answer 238

Controversial EKG and Echo - discouraged if asymptomatic Use if HCM suspected

Answer 239

LCA goes between aorta and pulm artery and is constricted when eversizing 2nd MCC of on-field death

Answer 240

Stage I w/o end organ damage may Stage II may not

Answer 241

Coughing, wheezing, chest tightness, begin during and worse 5-10 minutes after stopping

Answer 242

Albuterol 20 minutes before exercise

Answer 243

Can play sports

Answer 244

In mono - should avoid

Answer 245

Only a contraindicationif comorbid conditions such as HTN

Answer 246

Common in boys 12-15 and girls 11-13 Pain aggravated by quad movement, can inhibit activity Resolves as athlete reaches maturity

Answer 247

NSAIDs, PT, and Ice

Answer 248

Dance, cheer, gymnastics, running Low caloric intake w/ or w/o disordered eating Menstrual dysfunction Low bone density

Answer 249

Reduce training by 25% and increase intake by 200-600 calories F/u in 1-2 weeks

Answer 250

Cleared to play Cleared with additional f/u Not cleared